The economy, crime, abortion rights, and the wars in Ukraine and Israel appear poised to dominate the presidential election next year, but former President Donald Trump has already injected healthcare into the campaign, suggesting a perennial top issue will again play a role at the polls
Since enacting the Inflation Reduction Act of 2022, President Joe Biden and the Democrats have talked up its Medicare drug pricing and health insurance subsidy provisions, but haven't gotten much traction. Now, Trump has jump-started the healthcare debate by again proposing to repeal the Affordable Care Act of 2010, a goal that eluded him during his presidency.
“The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives," Trump posted Saturday on Truth Social, his social media platform.
Trump often promised to replace the ACA during his first campaign and his four years in office, but never produced a plan to do so. After immediate criticism of his fresh declaration, he doubled down Wednesday, declaring in another post, “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!”
The Biden campaign saw a political opportunity and immediately seized it. Joe Biden for President released statements, held conference calls with reporters and organized events with surrogates including former House Speaker Nancy Pelosi (D-Calif.) and Gov. Roy Cooper (D-N.C.), whose state formally expanded Medicaid under the ACA as of Friday.
On Thursday, the Biden campaign began airing healthcare-focused television advertisements in swing states including Arizona, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin.
The spots suggest Biden aims to broaden the healthcare debate beyond "Obamacare." The TV ad features a pediatric nurse from Nevada and goes beyond the issue of the Affordable Care Act to strike a populist, progressive tone and target corporate profits and Trump's healthcare record.
"The last administration's policies were so troubling. And our healthcare system has become a business, and people are becoming billionaires off the backs of sick people," the nurse, identified only as Jody, says. "The idea that we could go back to the policies that help the rich get richer and left so many people behind—I don't want to go back."
Trump's latest sallies against the ACA may cheer some of his supporters, but the history of failures to "repeal and replace" and polling data suggest the issue is a political loser.
"Whenever campaign debates turn to healthcare, they favor Democrats," said Larry Levitt, executive vice president for health policy at KFF. "Voters have historically trusted Democrats more than Republicans on healthcare."
A KFF survey conducted shortly before Trump revived his ACA attacks reaffirmed that sentiment, finding that voters favor Democrats over Republicans on the ACA and healthcare affordability by 59% to 39%.
Levitt noted that while the ACA suffered political backlash in its early years, public attitudes reversed during the GOP's final failure to undo the law in 2017. Recent surveys from KFF and others find support for the ACA running at around 60%.
In this election, inflation remains the top issue, according the KFF poll results, which published Friday, with 86% of voters saying it's a matter that's "very important" for candidates to talk about. That is followed closely by affordability, with 80% saying it's very important.
Trump's decision to elevate healthcare helps Democrats, which explains why Biden capitalized on on it, said Chris Borick, the director of Muhlenberg College Institute of Public Opinion.
"Trump's introduction of that issue isn't one that I think a lot of Republicans are very excited about," Borick said. "They've gone down that road, and over time seen that issue really flip in terms of public opinion. It isn't 2010 anymore, and I think it's a place where Biden would love to be spending more time."
Spending more time on healthcare could also help Democrats with the inflation argument. The KFF survey shows the public trusts Republicans to handle inflation more by 54% to 45%. While Democrats have been touting the Inflation Reduction Act, the survey revealed its drug cost elements are largely unknown, with just 32% of respondents aware a law exists that allows Medicare to negotiate some drug prices. Only 13% know there's a law to penalize drug companies that raise prices faster than inflation.
"It’s always a challenge for incumbent presidents to run on their records, rather than a forward-looking agenda," Levitt said. "Voters want to know what new you’re going to do for them, not what you’ve already done. Trump’s new vows to repeal and replace the ACA give Biden an opportunity to talk about his healthcare accomplishments."
Borick suggested attacking the ACA may still be useful to Trump because it retains resonance with GOP stalwarts who vote in primaries and contribute money, but he didn't see it helping in the general election. "If it's a long-game strategy, it is not a good one," he said.